- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4.90 / $51.29 / $89.13
| Facility | | $4.90 | $51.29 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.69 / $3.31 / $7.59
| Professional | | $2.69 | $3.31 | $7.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.19 / $2.51 / $17.78
| Professional | | $2.19 | $2.51 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $8.13 / $15.85 / $15.85
| Facility | | $8.13 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.66 / $2.40 / $3.31
| Professional | | $1.66 | $2.40 | $3.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.51 / $7.41 / $16.60
| Facility | | $2.51 | $7.41 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.86 / $2.51 / $5.50
| Professional | | $1.86 | $2.51 | $5.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $6.46 / $6.76 / $6.76
| Professional | | $6.46 | $6.76 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $3.16 / $7.24
| Facility | | $2.95 | $3.16 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2.95 / $6.31 / $7.08
| Professional | | $2.95 | $6.31 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $89.13 / $89.13 / $186.21
| Facility | | $89.13 | $89.13 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1.95 / $3.63 / $6.46
| Facility | | $1.95 | $3.63 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1.82 / $2.57 / $5.13
| Professional | | $1.82 | $2.57 | $5.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $79.43
| Facility | | $79.43 | $79.43 | $79.43 |